POS1184 EPIDEMIOLOGICAL CHARACTERISTICS OF VIRAL HEPATITIS IN PATIENTS WITH RHEUMATIC DISEASES – IMPLICATIONS FROM TREASURE DATABASE
Authors: D. Ersözlü, M. Ekici, B. N. Coşkun, S. Ö. Badak, E. Bilgin, U. Kalyoncu, B. Yağiz, Y. Pehlivan, O. Küçükşahin, A. Erden, D. Solmaz, P. Atagündüz, G. Kimyon, C. Bes, S. Colak, R. Mercan, T. Kaşifoğlu, H. Emmungil, N. A. Kanitez, A. Ateş, S. S. Koca, S. Kiraz, A. İ. Ertenli
Journal: Annals of the Rheumatic Diseases (2022)

Background Recent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation. Objectives This study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background. Methods The prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads. Results A total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1). Table 1. Serological analyses in the study group RA SpA p N n (% ) N n (% ) Hepatitis testing 2896 2809 (97.0) 5444 5130 (94.2) &lt;0.001 HBsAg positivity 2750 71 (2.6) 5017 99 (2) 0.080 Anti-HBs positivity 2708 876 (32.3) 4893 1663 (34) 0.147 Anti-HBc positivity 2362 480 (20.3) 4194 524 (12.5) &lt;0.001 HBV-DNA positivity 454 16 (3.5) 637 35 (5.5) 0.129 Anti-HCV positivity 2602 22 (0.8) 4627 16 (0.3) 0.005 The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir. Figure 1. Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groups Conclusion The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis. Disclosure of Interests None declared